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ICU > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

What are 5 causes of ALT >1000

A
  1. Vascular (shock liver, portal venous thrombosis, Budd Chiari)
  2. Toxic (ie. acetaminophen)
  3. Viral (hep, CMV, EBV, HSV)
  4. Metabolic (autoimmune, Wilson’s, acute fatty liver of pregnancy)
  5. Lymphoma
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2
Q

Name 8 complications of fulminant hepatic failure

A
  1. Hepatic encephalopathy
  2. Cerebral edema
  3. Coagulopathy
  4. Metabolic acidosis (lactate)
  5. Hepatorenal syndrome
  6. Electrolyte abnormalities (hypoK, hypoNa)
  7. Hypoglycemia
  8. Increased risk of infection
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3
Q

What are 3 options for treatment of hepatic encephalopathy?

A
  1. Lactulose
  2. Metronidazole
  3. Dietary protein restriction
    Improves symptoms
    None are proven to improve mortality
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4
Q

Define spontaneous bacterial peritonitis (lab values for peritoneal fluid analysis)

A

PMNs >250 x 10^6

WBC > 500 x 10^6

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5
Q

What are initial physiologic goals in a patient with severe TBI?

A
  1. Avoid hypoxemia (PaO2 80-120 mmHg)
  2. Normocarbia (PaCO2 35-40 mmHg)
  3. Avoid hypotension (MAP >65)
  4. CPP 60-70
  5. Normal temperature (35.5-37 celcius)
  6. Normoglycemia (5-8 mmol/L)
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6
Q

What are 5 anti-pseudomonal antibiotics

A
  1. Piperacillin-Tazobactam
  2. Meropenem, imipenem
  3. Ciprofloxacin
  4. Gentamycin, tobramycin
  5. Ceftazadime
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7
Q

What antibiotics cover against MRSA?

A

Hospital acquired: vancomycin, linezolid

Community acquired: clindamycin, tetracycline, doxycycline, TMP-SMX (variable resistance)

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8
Q

With fungemia, where to suspect other infections?

A
  1. Endocarditis
  2. Line/indwelling catheter infections
  3. Opthalmic (get ophtho consult)
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9
Q

What are 5 common cell mediated immune dysfunction categories?

A
  1. Malignancy
  2. Diabetes
  3. Immunosuppression
  4. Third trimester pregnancy
  5. Cirrhosis
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10
Q

Why are steroids added in treatment of meningitis?
What is the typical dose?
When should you time the delivery of steroids?

A
  1. Decreases overwhelming cytokine response as a result of bacterial cell wall lysis from bacteriocidal antibiotics
    This cytokine release in response to bacterial wall debris is thought responsible for inflammation and swelling
  2. Dexamethasone 10 mg IV q6h x 4 days
  3. Before or at time of first dose of antibiotics
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11
Q

What antibiotic coverage is needed for Listeria monocytogenes?

A

Ampicillin (not covered by 3rd generation cephalosporins)

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12
Q

What bacteria should you consider in asplenic patients?

A

Encapsulated

S. pneumoniae, H. influenza, N. meningidites, Klebsiella, S. aureus

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13
Q

How does the spleen play a role in humoral immunity? (3 mechanisms)

A
  1. Filter for bacteria with antibodies
  2. Reservoir for B-lymphocytes, which are activated into plasma cells to make more antibodies
  3. Alternate complement pathway housed in spleen
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14
Q

If a patient has cell mediated immune deficiency, what type of bacteria causes problems? Give 3 examples

A

Intracellular organisms
Listeria
Legionella
Salmonella

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15
Q

What type of bacteria is Stenotrophomonas maltophilia? What types of patients do we see with it?

A

Gram negative, aerobic (closely related to pseudomonas)
Opportunistic - adheres like biofilm
Hospitalized (ICU), immunocompromised

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16
Q

Treatment options for Stenotrophomonas?

A

TMP-SMX

Intrinsically resistant to beta-lactams, aminoglycosides, carbapenems, fluoroquinolones

17
Q

7 causes of high fever (T>38.9)

A
  1. Infection
  2. Drug fever
  3. Transfusion reaction
  4. Extensive tissue necrosis
  5. Neuroleptic malignant syndrome
  6. Heat stroke
  7. Toxic (salicylates, thyrotoxicosis, sympathomimetics etc)
18
Q

How long to treat ventilator associated pneumonia? - relevant trial?

A

8 days, consider longer if Pseudomonas

RCT: 8 days vs. 15 days
French multicentre RCT, n = 401
similar mortality, morbidity and recurrent infections

19
Q

What should you consider in patients on broad spectrum antibiotics >1 week who develop fever/sepsis picture?

A

Fungal super-infection

20
Q

7 Causes of antibiotic failure

A
  1. Wrong diagnosis (non-infectious)
  2. Wrong dose
  3. Inadequate drug penetration (abscess, BBB, foreign body)
  4. Inadequate empiric coverage and incorrect spectrum
  5. Superinfection
  6. Drug interactions leading to antibiotic inactivation
  7. Unusual pathogens (Rickettsia, Chlamydia, parasites)
21
Q

What are 4 classes of risk factors that predispose patients to aspiration?

A
  1. Altered level of consciousness
  2. Dysphagia
  3. Neurological disorders
  4. Mechanical disruption of barrier mechanisms
22
Q

Diagnostic criteria of Streptococcal Toxic Shock Syndrome?

A
  1. Isolation of Group A Strep from normally sterile site (blood, CSF, pleural, peritoneal fluid, tissue biopsy, surgical wound)
  2. Hypotension (SBP <5th percentile peds)
    2 or more of the following:
    A. Renal dysfunction
    B. Coagulopathy
    C. Liver dysfunction
    D. ARDS
    E. Erythematous macular rash, may desquamate
    F. Soft tissue necrosis (nec fasc, myositis, gangrene)
23
Q

Diagnostic criteria of Staphylococcus Toxic Shock Syndrome

A
  1. Fever > 38.9 degrees celclius
  2. Hypotension sBP /= 15
    a. Orthostatic syncope or dizziness
  3. Rash – diffuse macular erythroderma
  4. Desquamation – 1-2 weeks after onset of illness, esp. palms and soles
  5. Multisystem involvement (3+)
    a. GI: vomiting/diarrhea at onset of illness
    b. MSK: severe myalgias, CK elevation >2x ULN
    c. Mucous membranes: vaginal, oropharyngea or conjunctival hyperemia
    d. Renal: BUN or Cr >2x ULN or pyuria
    e. Hepatic: bilirubin or transaminases >2x ULN
    f. Hematologic: platelets <100,000/microL
    g. CNS: disorientation or alterations in consciousness without focal neuro signs in absence of fever and hypotension
  6. Negative results on the following tests
    a. Blood, CSF, throat for another pathogen, blood may be + for S. aureus
    b. Serologic tests for RMSF, leptospirosis or measles
24
Q

DDx abrupt onset shock in previously well individual

A 
Staph TSS
Gram negative sepsis
Typhoid fever
Rocky Mountain spotted fever
Meningococcemia
Strep pneumo infection
Heat stroke
25
Q

5 complications of SAH?

A 
Rebleed
Vasospasm
Seizure
Obstructive hydrocephalus
Neurogenic pulmonary edema
26
Q

What are 3 indications to stop a procainamide infusion?

A
  1. Cessation of arrythmia
  2. Full dose has been administered
  3. Hypotension
27
Q

What are 3 major life threatening complications of massive hemoptysis (pulm hemorrhage)

A

Airway obstruction
Impaired gas exchange
Hypotension

28
Q

What is the anatomical etiology of massive hemoptysis

A

Bronchial arteries ** most common
High pressure, come off aorta
Pulmonary arteries

29
Q

What are 12 major etiologies of massive hemoptysis

A 
Iatrogenic (procedure related)
Infectious (necrotizing, TB) 
Malignancy
Bronchiectasis 
Pulmonary embolism 
Drug induced (cocaine, crack, amiodarone, penicllin, transplant drugs)
SLE
Vasculitis (Goodpasture's, Wegner's, 
Coagulopathy
Heart failure (MS, MR w/ pulm edema)
Trauma
AVM
30
Q

What can we do in the ED while awaiting more definitive management for massive hemoptysis or diffuse alveolar hemorrhage

A
  1. Airway capture with large bore ETT (8.0)
  2. Head down
  3. Ventilate with affected lung in dependent position (lung down)
  4. Correct coagulopathies if present
  5. Consult Pulmonary/Thoracics/Anesthesia as necessary
31
Q

5 etiologies of necrotizing pneumonia

A 
Staphylococcus aureus
Klebsiella pneumoniae
Pseudomonas aeruginosa
Nocardia
Actinomyces
Aspergillosis
32
Q

What are 4 major CNS effects in hypoglycemia?

A
  1. Delirium
  2. Coma with multifocal brainstem abnormalities with preserved reflexes (decerebrate posturing)
  3. Focal neurological deficits
  4. Seizures
33
Q

What are 3 other clinical signs of hypoglycemia

A
  1. Hypothermia
  2. Cardiac dysrhythmias (sinus tachycardia, afib, PVC’s)
  3. Anginal chest pain
34
Q

What is the management of insulin overdose?

A

Supportive dextrose therapy
Monitor electrolytes (potassium)
Use bolus +/- infusion of D5/10/25 as needed
Glucagon is NOT recommended, can induce insulin release from pancreas

ICU (6 decks)

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